Immediate hemodynamic management following subarachnoid hemorrhage during embolization of cerebral vascular abnormalities.

Three patients are reported who suffered intracranial hemmorrhage during interventionally neuroradiology procedures. All had severe hypertension, cardiac arrhythmias and loss of consciousness. Immediate CT scan showed small amounts of blood in all patients. Arrhythmias were controlled with lidocaine. In two patients, the hypertension was treated only with barbiturates plus fentanyl and in the third with labetol and nitroprusside. In the patient treated with nitroprusside and one patient with barbiturate plus fentanyl a 14-20 min period of hemodynamic stability was followed by vasomotor collapse requiring intravenous vasopressor support. The patient initially treated with nitroprusside suffered irreversibly brain injury whereas the other two improved neurologically following their intracranial bleed. These patients suggest that nitroprusside is detrimental in the acute treatment of malignant hypertension following intracranial hemorrhage.